Editor’s note: Some names have been changed to protect the identity of people interviewed for this story.

When Zafar was young, he wanted to become a professional footballer. Now, at 38, he recruits young men for his brother, who is one of several warlords in Lyari, a densely populated neighbourhood in Karachi, Pakistan. Lyari is as famous for its talented football players and rich culture as it is infamous for gang warfare and targeted killings.

“I am a victim of this system,” Zafar says, referring to his inability to isolate himself from a life crime. “Time in jail can transform innocent people into criminals.”

Zafar describes himself as non-violent. He spends some of his time managing a confectionery shop as a side-business. “I’m not involved in anything wrong,” he insists. His friends, sitting around him, laugh as a rejection of this claim.

We’re sitting inside journalist Saeed Baloch’s house inside the town. As an active member of the community in Lyari, Baloch has seen many young men stray down violent paths, going on to lead lives of crime and imprisonment. “Neglect leads to boys becoming militant,” he explains.

According to Baloch, as many as 3,000 young Lyari men — many of whom had committed crimes — have been killed in encounters by law enforcement agencies between 2013 and 2015.

Between 2003 and 2015, Pakistan has lost more than 20,000 civilians to acts of terrorism alone, according to the South Asia Terrorism Portal (SATP). The average age of men involved in crime and militancy remains dangerously low. According to Saeed, they often start being recruited when they turn 13.

“Young boys see the good life of gang leaders – their money and power leaves even community elders awestruck,” Baloch says. “When boys have no productive activity, they loiter around. Once they get inducted into a gang, they can never leave.”

Baloch’s 17-year-old daughter Muqaddas is a student of Pre-Medical Intermediate. “Boys are generally non-serious about education and seek other outlets,” she chimes in. “For us girls, education itself is the outlet.”

And gangs are only one of several violent paths that attract Pakistan’s boys. Baloch, and several others I spoke to for this story, said that while resources are spent on fixing the problems that come from neglecting these boys – crime, violence against women, terrorism, gang wars — not enough emphasis is placed on finding solutions to the neglect that leads them down those paths to begin with.

While opportunities for acquiring literacy and education may be available to young men, very few initiatives focus on counseling and mentoring them through adolescence.

“We have already lost too many boys due to negligence, too many chances at a good life missed out on,” says Mossarat Qadeem, a peace activist who works to bring back young men from militancy in Pakistan’s north-western province of Khyber-Pakhtunkhwa (K-P).

According to Mossarat, 35% of the population in Federally Administered Tribal Areas (FATA) are between the ages of 15 to 30 — and they don’t have access to a single university.

“We have no institutions that would help channel the energy of youth,” Mossarat adds. “This has left a huge gap and that gap is being filled by the wrong people.”

Mossarat’s organization, PAIMAN, reaches out to conflict-prone districts of K-P and FATA, hoping to counter the impacts of radicalisation and extremism. Mossarat and her team have helped rehabilitate some 1,230 boys since the organization first started in 2004. That’s a drop in the ocean.

There’s a correlation between high proportions of 15 to 29-year-olds in a population and a greater incidence of civil conflict, according to a UNFPA study, which means as the proportion of young people in a society increases, so does their likelihood to get in trouble, unless they’re provided with enough access to educations and honest livelihoods.

And nowhere is this need more dire than in South Asia. India has 356 million, the world’s highest number, of people aged between 10 to 24. Pakistan has 59 million and Bangladesh has 48 million.

“This dividend has turned into a demographic disaster,” says Dr. Farid Midhet, a demographer and director of Jhpiego, which focuses on maternal and reproductive health issues and adolescents, for Pakistan. “In coming decades, this problem will become very serious and possibly uncontrollable in the absence of a good education system for the poor urban and rural boys, an extensive system for vocational training including counseling and social training, social support and social security.”

Rebecca Hendin / BuzzFeed

Who’ll talk to the boys?

According to Baloch, most boys in Pakistan do not receive counseling, even from their own parents. “They simply don’t talk to each other,” he says. “Poverty is so all-consuming and keeps the parents so busy that they cannot focus on keeping their interest for education alive.”

Aman Tech, an initiative of Aman Foundation in Pakistan, is addressing this need. In addition to the hard skills and vocational training it gives to young men, it has made “soft skills” a part of its curriculum. This includes not just grooming and image-building exercises but also communication and social skills.

“When they come to us, it is amazing how out-of-touch with themselves these young men are,” says Mahida Baig, the departmental head of Soft Skills at Aman Tech. She says many young men who come there lack self-awareness and do not know how to encash themselves.

“The biggest reason is that they have not emotionally engaged with their parents, especially their fathers,” Baig says. “It’s just something that is not done in our culture.”

Baig says that when Aman Tech identifies a boy as aggressive, they provide one-on-one counseling. Instructors, who are approachable, act as mentors and guide students who confide in them about relationships and life decisions.

But according to Baig, a central challenge in the counseling process is combating the stereotypes of masculinity that South Asian boys grow up around.

In 2002, Promundo, an NGO focusing on promoting gender justice, launched a program called Program H, which primarily targets men between the ages of 15 to 24, and encourages critical reflection about rigid norms related to manhood. Promundo reports that after participating in their Program H activities, positive changes were seen in these young men. With sensitization that made them rethink gender roles, these boys had better attitudes towards relationships and family planning, participation in domestic work, not indulging in sexually harassment, and not perpetrating domestic violence.

Unlike many of the young men, the girls in Lyari are focused and are better students, says Nadeem Ghazi, a peace activist from the area who works on peace-building through education from the forum of his organization Peace Education Welfare Organization(PEWO). “Girls are more motivated to get an education,” he says. “Boys come under a lot of unhealthy outside influence.”

If boys are a problem, they must be engaged as part of the solution, says Rujuta Teredesai, co-founder and executive director of a social enterprise called Equal Community Foundation (ECF) dedicated to engaging men to end violence and discrimination against women.

According to Teredesai, development projects are focusing on girls because girls are not able to access enough opportunities for education and training. “However, if we exclude boys, we are not addressing some of the root causes; we might be creating a bigger problem.”

Experts say that a lack of focus on young men will actually set back the programs that focus on empowering women.

“All of the gains we have made for women and children can be reversed if we don’t pay attention to what is happening, or not happening, to young men,” says Leith Greenslade, vice chair, MDG Health Alliance and Office of the UN Special Envoy for Financing the Health MDGs. Greenslade says rising numbers of young, uneducated men without job prospects can be distracted by violent, anti-woman ideologies. “These ideologies can lead to civil unrest that can destabilize entire societies. Once the level of violence rises to these levels, we see the gains for women and girls unravel quickly.”

Rebecca Hendin / BuzzFeed

Talking solutions

Teredesai says that work with boys should be done in three major areas: Engaging them as allies, providing them with opportunity to learn about these issues, and catering to their needs.

“None of these approaches can work in isolation,” she says.

And according to Mossarat, the answer to how young men can be mitigated from being recruited into violence and radicalization lies in preventive measures taken before the damage is done.

“We need vigilant communities in society. We need the media to play its role to spread awareness. And we need parents to allow their sons to talk to them about everything,” Mossarat says.

“Because once they get inducted into violence, get radicalized and are caught in that web, it is a tumultuous task to bring them back.”

The world is realising that due to cultural norms, adolescents and young people often do not discuss contraception with their elders or family members. PHOTO AFP

They can curse in each other’s presence, break traffic signals in unison and smoke together, and they may at times act macho and show off their romantic escapades. But young men, like their elders, do not readily open up about reproductive issues. Parents or teachers do not discuss subjects of a sensitive nature with them. While it is the same with adolescent and young women, they are comparatively more open to confiding in each other and getting guidance.

But it seems the world may be in for a change in attitude. Young men, all over the world, are stepping up to take part in reproductive discourse.

“This is the first time I sat on an airplane. I nearly never came,” he says, sharing the long journey of how he first reached Jordan from his home in Gaza.

He explained that he was sent away and told to go back due to lack of a no objection document, but he stayed near the border and went back the next morning, and was finally let into Jordan from where he flew to Bali.

A tad bit shy by nature, he confesses that the most difficult subject to talk about with boys his age is sexuality. Yet it seems that the world is realising that due to cultural norms, adolescents and young people often do not discuss these issues with their elders or family members. With their own age group, if they feel safe enough, they can talk about the typically hushed topics too. Y-PEER, a youth network of young people from more than 700 non-profit organisations and government agencies in more than 50 countries initiated by the United Nations Fund for Population Activities (UNFPA), uses an integrated approach to work with young people on subjects like gender, contraception and reproductive health. This year the thrust of all the discussions at ICFP was how to involve youth in the process. Half of the world’s population today, which is over 3.5 billion people, is under 30, mostly living in developing countries. They need guidance on these matters and silence may not be feasible anymore.

“If you’re not on the table you’re on the menu. How do we bring the youth on the table to talk about family planning?”

Pakistan is currently the world’s seventh most populous nation, according to the registered number of Pakistani, 199,085,847 in July 2015, as per the CIA Factbook. Contraception is thus an important subject that should be included in the nation’s narrative at all levels. In Pakistan too, this working via youth strategy has found a foothold.

Muhammad Shahzad, the executive director, has in tow young leaders wherever he goes. At the ICFP, too, he is watching out for and introducing proudly bright young people from Pakistan. One of them is 24-year-old Qaisar Roonjha, who says working with and for people his age is something he just has to do. His organisation, WANG (Welfare Association for Young Generation), is youth-led, and its primary focus is to struggle for a fairer society. Important buzz words like Youth Development, Women Empowerment, Mother and Child Health, Young Girls Education, Gender justice, Peace Promotion, Youth Development and livelihood security are all highlighted on the WANG website. From Lasbela in the perilous province of Balochistan, Qaisar has come a long way.

“I have met at least 40,000 young people all over Pakistan in the last five years,” he says with pride.

He shares that the toughest subject to tackle while talking to young people in Pakistan is gender equality.

“They still seem ready to discuss contraception. At least the married ones do. But seeing women as equal partners is difficult,” adds Shahzad.

Qaisar, whose video was selected for a competition held by organisers of the ICFP, attended the high profile conference in Bali as a moderator.

Ayesha Memon, an MBA student and youth leader from Hyderabad, also won the same recognition for her video, and addressed groups of interested activists and experts at the ICFP.

“Young people need to come out of their boxes; we should not assume things can’t change.”

Sharaf Boborakhimov is no novice at engaging with his peers on some of the trickiest subjects, which especially boys never openly talk about. Originally hailing from Tajikistan, he currently lives in Sofia, Bulgaria. This graduate in International Economy joined Y-Peer in 2011.

“What we do is provide safe spaces to youth where they can talk about sensitive subjects to people their own age. The peer-to-peer methodology works in tackling these subjects. We choose each word very carefully. We have to memorise manuals to know what to say and what not to and how to approach a subject.”

He has a close eye on the Syrian crisis, has Syrian friends, and has worked in Jordan closely with Syrian refugees who have made the Zaatari Camp their permanent home.

“We specially trained couples so that they could go back in the camps and train others. The refugees are just like any other couple. All they want is peace. They are depressed and frustrated no doubt. But in them I see a vision and a hope for a better tomorrow. They need guidance about contraception too.”

Theatre-based peer education, in Sharaf’s view is most effective for youth, whether they are refugees or not, the same strategy Chanan begun with.

“Since 2009, we have recruited some 50,000 young people for Y-Peer who work with us to educate their peers in important matters like sexual and reproductive health rights and also contraception,” Shahzad shares, adding that Pakistan was the first country in Asia Pacific that introduced UNFPA’s Y-Peer program in the region in 2009.

They are working with youth across 135 districts spread all over Pakistan including its toughest regions. In Pakistan, 65 per cent of the population is under 29, and 40 per cent fall into the even narrower age bracket of 10 to 24 years, says Shahzad.

“A big focus of our work is to engage with policymakers,” he says, sharing that Chanan was part of the National Task Force of 2009 for youth policy development, and is hosting the National Secretariat for Y-Peer in Pakistan.

“There are two million people in Gaza. The blockade is continuing since two years. Aid and medical help is almost impossible. Unemployment in my people is 70 per cent; among the youth it is 55 per cent. The healthcare system is fragmented. Very few people are able to reach the government-run healthcare centres.”

“In shelters that he has worked in, two to three thousand people were staying in one school. That meant each classroom was housing at least 50 people. Men, women and children, all strangers for each other, crammed into one room. With no food and water at least for the initial days till help started trickling in. Do you think family planning is a priority for them on a hungry stomach?”

In difficult situations and at such a young age, to be taken seriously and sensitise people about contraception is an uphill task. But these young people have realised that their generation’s reproductive choices will shape future demographic trends. They are thus helping their peers make informed decisions.

QUETTA / KARACHI: For 25 long years, Sursan Bibi guarded a secret, one that she has only told her husband, Musa Khan, about. Sursan had an obstetric fistula, the pain of which is only exacerbated by the sense of shame that comes with leaking urine uncontrollably.

The prospect of treatment only came up recently, when a flyer about fistula and its treatment reached her village. Travelling 400 kilometres from Harnai district, her eldest son Hazrat brought her to Quetta. While her surgery was successful, Sursan, now 65, regrets the years of her life that were wasted.

Known as ‘the poor woman’s disease’, the obstetric fistula develops in prolonged labour when the mother cannot seek proper medical care or reach a trained midwife in time. “The baby’s head may get stuck in the birth canal and if it keeps pushing against the thin wall between the birth canal and the bladder or rectum, it causes a tear,” explains Dr Suboohi Mehdi, a surgeon at Karachi’s Koohi Goth Hospital, Pakistan’s most well-known hospital for the treatment of fistula. The result is urine or stool incontinence. For such women, who leak waste continually and are ostracised from society, normal life becomes a distant dream.

Sursan, married too early, gave birth to five children at home with the help of a dai (traditional birth attendant). In her village, the women are allowed to leave their homes only to visit relatives or take cattle for grazing; they are not allowed to seek medical help without being accompanied by their male relatives.

A day after her third child was born, she started to leak urine. The smell was unbearable. The dai told her husband that it would get better in a few days but days turned into decades, during which she bore two more children. Unlike most women suffering from this condition, Sursan’s husband didn’t abandon her.

Parts of Balochistan, like most underprivileged parts of Pakistan, have a high incidence of fistula. United Nations Population Fund (UNFPA) provincial coordinator Ahsan Tabasum, talking to The Express Tribunein Quetta, says that the UNFPA and Pakistan National Forum for Women Health (PNFWH) are working together to eradicate this disease from Balochistan.

“We have centres for fistula treatment in three hospitals in Quetta, where the patients are treated free of charge,” he discloses. Around 515 patients have received treatment here since 2006, with a success rate of over 90 per cent, while the UNFPA has helped over 5,000 women in Pakistan with surgical treatment for the disease through its seven regional centres in the country.

A lot of women travel all the way from all provinces to Karachi to get treatment at Koohi Goth Hospital. Surgeons here are trying to salvage 33-years-old Gulzada Zaman’s bladder. But for Gulzada, it may already be too late. “If only a skilled midwife would have told her in time that her next delivery should be surgically done, this girl’s life could have been saved,” laments Noor Gul, a midwife who has been serving at Koohi Goth since nine years. “The lack of awareness, and how easily the disease can be avoided, is very frustrating. Doctors cannot always reach far flung areas, so the key is having trained midwives in every part of Pakistan,” she says.

Noor and her colleagues have to not only bathe and clean the patients who arrive after strenuous journeys, but also have to psychologically counsel them and make them believe that they are not “unclean”. Complicated cases require more than one surgery, and treatment and rehabilitation can take months.

Another kind of fistula, fast increasing in number, is the iatrogenic fistula which develops when an unskilled surgeon performs a surgery poorly due to malpractice and lack of training.

UNFPA has supported more than 5000 women to receive surgical treatment for fistula in Pakistan through their seven regional centres in the country. The campaign involves three key strategies – prevention, treatment and social reintegration of survivors. Yet, more needs to be done. According to Tariq Nisar, Media Coordinator for PNFWH, “an estimated 3000 to 5000 year new cases develop each year in Pakistan.” Women like Sursan who suffer from obstetric fistula are usually among the hardest to reach, and are often illiterate and with limited access maternal and reproductive health care. With gender and socio-economic inequality, lack of schooling, child marriage and early child bearing already holding back Pakistan’s underprivileged women, patients smelling due to the fistula suffer from further marginalization. Even when cured, the psychological impacts remain, and many are abandoned by families too.

Meanwhile, Sursan Bibi’s smile has returned. “I will not advise any woman in my village to go to the dai,” she vows. “Instead, I will urge them to visit the gynaecologist.”

These people who are making this world a better place include those who are off the silver screen and performing stage, but are remarkable human beings.

For a moment, I felt star-struck, as Alicia Keys entered the room bustling with journalists from world over. We, a varied group of journalists, had been invited by the United Nations Foundation (UNF) to report on and learn from the experience of being in the United Nations (UN) Headquarters in New York for the UN General Assembly and the Climate Summit 2014.

All of us are fans of the many celebrities that we saw all around us in those few days. But once done with the initial gushing and surreal feeling of being in the presence of “stars”, we not only saw these goodwill ambassadors in a different light, but rediscovered them as bigger celebrities than we thought.

Anyone who has been inside the UN knows that the gray concrete flooring and white lights give it a formidable and cold ambiance. The warmth, then, came through these stars and the work they are doing. These people who are making this world a better place include those who are off the silver screen and performing stage, but are remarkable human beings. Like celebrated humanitarian Graca Machel, the widow of Nelson Mandela, who punctured the bubble of world leaders by criticising their speeches over the issue of climate change. Or like the lesser known unsung female hero from Papua New Guinea, Ursula Rakova, who has pioneered an environmental movement that will save lives of generations.

Among the many celebrities from the performing arts who have embraced real life heroism by contributing to worthwhile causes, here are a few who made the mark this year at the UN:

1. Leonardo DiCaprio

“Honoured delegates, leaders of the world, I pretend for a living but you do not.”

Photo: Reuters

With an overgrown beard, a caveman look, DiCaprio looked different. But for once, it was not about his looks, his acting or his personal life. While friends sent messages asking why he had the bearded look, all I could hear was words that will go towards changing the life of millions.

His speech on the issue of climate change has been hailed as a game changer, calling upon world leaders for understanding and action. He began by saying,

“I stand before you not as an expert but as a concerned citizen, one of the 400,000 people who marched in the streets of New York on Sunday, and the billions of others around the world who want to solve our climate crisis”.

DiCaprio was referring to the People’s Climate March in Manhattan that brought attention to the issue like never before.

“I play fictitious characters often solving fictitious problems. I believe that mankind has looked at climate change in that same way,” said DiCaprio, ruffling just the right feathers.

2. Alicia Keys

“It’s not about me. It’s about we.”

Photo: Indrani Basu

As she sang the song We are here… for all of us, the theme song for her campaign, sniffs from the audience were audible. She told the crowd to hold the neighbour’s hand, a human chain, and we all did, experiencing a powerful moment.

“The song We are here is born from a very special place. The backdrop is everything that is going on in the world. There has been one issue after another: Syria, Nigeria, Gaza, Israel, Ferguson. I wanted to do something but did not know what. I used to have anxiety hearing about all of this. I would literally ache. There was a lot of what if, could we, would we! This work and this song is a dream come true,” said a visibly pregnant and highly motivated Keys.

Here, Keys pledged a million dollars to her We Are Here Movement at the fifth annual Social Good Summit. This Summit is defined as a convening of world leaders, media and technology leaders, activists working on grassroots, UN experts and voices from around the globe.

3. Emma Watson

“If not me, who? If not now, when?”

Photo: AFP

We always knew that this young woman who played the genius Hermione Granger in the Harry Potter series is brilliant. But her masterstroke came as she redefined feminism as the UN Female Goodwill Ambassador. Watson extended an invitation to the men of the world to fight sexism. She spoke at the launch of the #HeForShe campaign which is a solidarity movement for gender equality.

“Men, I would like to take this opportunity to extend you a formal invitation,” she said.

“Gender equality is your issue too.”

“For the record, feminism by definition is: ‘The belief that men and women should have equal rights and opportunities. It is the theory of the political, economic and social equality of the sexes,’” said the remarkable young woman.

Watson has become, through this, a champion not just for women’s rights, but also a hero of many men world over, who agree with her that equal opportunities between the sexes cannot come around if only half of humanity is invited to participate in the conversation. Watson touched upon how feminism is often misconceived and associated with “man-hating”.

4. Kajol

“Help a child reach five.”

Photo: Twitter

Championing the cause of maternal and child health, Kajol graced the 69th annual UN General Assembly summit. She has been part of an active hand-washing campaign, Help A Child Reach Five, that aims at improving health of children and guarding them against illness and death in infancy and the age group under five years.

Kajol, in a tech savvy manner, used Twitter well to get the message of propagating this life-saving habit across.

“The cause is getting requisite attention through social media. It is reaching out to a lot more people.”

5. Linkin Park

“We encourage our fans to be more vocal about these things.”

Photo: United Nations Facebook page

Humble, sober and focused, Linkin Park singers Chester Bennington and Mike Shinoda are very serious about making the world a better place, and they mean it. At the Climate Summit, they renewed their continued support for sustainable energy.

“Our message is very clear. Be bold and strong. We are counting on you guys to make the change. A fan is not someone who just thinks you are hot. It is someone whose trust you have won,” said Bennigton and Shinoda.

Their organisation Music for Relief does miscellaneous work for disaster relief and renewable energy causes.

Dr Saboohi Mehdi is one of Pakistan’s 38 surgeons who aretrained to repair fistulas, but few of these 38 surgeons work in thisfield. “It pays no money, so most don’t want to pursue this. But Ican’t do anything but this.”

KARACHI:

She wept inconsolably, and the doctors at Koohi Goth Hospital Karachi could not understand why. They had treated this young woman in her 20s already, and they were ready to discharge her so that she could go back to her family near Pakistan’s border with Afghanistan.

A translator was brought in who told them the real problem. “My first born is with the money-lenders as girwi (mortgage). I developed the fistula during his birth. But I was so desperate to be healed of this constant leaking that I took the chance. I needed money to reach here to get treatment.” Doctors at the hospital raised the money and sent her home. One life saved out of the nearly 5,000 women that develop the fistula every year in Pakistan. But thousands await treatment.

For fistulas, precaution is the best cure. And the cure is simple: Women of Pakistan need to deliver babies into trained hands and with basic health care facilities. This cure is still a distant dream.

Snuggled away in the outskirts of busy Karachi, Koohi Goth Hospital is Pakistan’s only hospital exclusively built to end the scourge of this preventable disease. Only, there should be not even one fistula hospital in Pakistan, because fistulas should no longer exist. “The last fistula case in England was in the 1920s. Here we are with 5,000 new cases every year,” says Dr Shershah Syed, founder of this hospital.

“If the labour is prolonged, the baby’s head can get stuck in the birth canal. If it keeps pushing against the thin wall between the bladder or rectum and the wall of the birth canal, thereby causing strain,” says Dr Suboohi Mehdi, one of the surgeons at Koohi Goth Hospital.

Another way a fistula may be formed is if, by mistake of an unskilled surgeon, a cut is caused in the bladder or rectum during surgery. “We are able to treat just 500—600 every year. Lack of awareness and no accessibility to treatment facilities is the reason,” says Dr Sajjad Ahmed, project manager Fistula Project. The project, run by Pakistan National Forum on Women’s Health (PNFWH) and UNFPA, has treated some 3,400 women since it started off in 2006.

Women suffering from fistulas leak urine or stool uncontrollably. Because of this, they are socially ostracised and lead isolated lives. The fear of leaking leads to them starving themselves, which in turn leads to malnourishment-related problems. They miss basic joys like socializing and traveling by public transport.

“I have forgotten what a normal life is. All I have done the last four lives is wash clothes,” says 40-year-old Rihana from interior Sindh. Rihana cries easily; she knows her case is a complicated one. “I don’t know how I will fix her. Sometimes, the cases are so messed up by the time they come to us that there is little we can do,” says Dr Mehdi.

“The first thing we do when a lot of them reach here is give them a shower,” says the dedicated Noor Gul, a senior nurse at the hospital. Gul is now a trainer, helping train young girls who come to the Koohi Goth Midwifery School and Hostel. Once trained, these girls will go back to their communities and be able to help deliver babies safely, so that more women do not develop this disease.

In a message on this day, the President Society of Obstetricians and Gynecologists of Pakistan (SOGP), Dr Tasneem Ashraf correctly points out that doctors must identify high risk patients for fistula development, especially pregnant women below the age of 20 years or above the age of 40 years, women who have given birth to many children, those suffering from obesity or Anemia, or having larger than normal babies.

Husbands on Board

Naz Bibi is tiny in stature but gives a resolute smile. Suffering from a fistula since the last nine years, this woman in her 40s has come to Karachi all the way from Goth Dera Bugti. She lies on a plastic sheet spread out under her, and can’t wait for the day when she will be dry once more. “Every one left me. Family, friends. I smelled all the time. I leaked non-stop. Yet, my husband was the only one in my life. He brought me here,” she says.

Naz Bibi from Dera Bugti, Balochistan, has been suffering fromthe condition for nine years. “Everyone left me but my husband. On wayto Karachi, travelling was tough in the bus because fellow passengerswere disgusted with my stench. I hope that will be over soon.”

“We are seeing a definite positive change in the trend. More and more husbands now support their wives through the ordeal,” says Dr Ahmed.

“My husband brought me here all the way from Sialkot,” says Fozia, who developed a fistula during the birth of her first child. “I am so excited! Once I heal, I will be able to say my namaz. I have not been able to pray for the last seven years”.

Facts in numbers

Fistula is a poor women’s disease, and the patients are 99 per cent poor women who cannot afford to get their child delivered under proper medical care.

Every year, Pakistan has 4,500—5,000 new cases of fistula. Out of these, only 500—600 reach doctors for treatment.

Pakistan has an estimated 38 surgeons who can perform fistula repair surgeries, but because this is not a lucrative line of medicine, only an estimated 15 are regularly working in this field.

Read this & realize your blessings! You can save a woman’s life by donating to Koohi goth Fistula Hospital Karachi.

Only 30 surgeons in Pakistan can treat the condition. PHOTO: SARAH MUNIR

KARACHI: It is 99.9% a disease of extremely poor women. Nobody from the affluent families will suffer from it. So long as its poor women, no one cares, says Dr Shershah Syed, the man responsible for setting up Koohi Goth Hospital, the only primary healthcare facility for women suffering from the condition called fistula.

He has made possible the treatment of 10,000 women suffering from the unthinkable medical condition. Yet, it’s not enough. Every year, the list of women who are suffering from a fistula increases by 5,000 approximately, and trained surgeons in Pakistan who can perform the surgery that can cure them are just 30! Yet, there is light at the end of the tunnel.

Selling goats to get treatment

Nineteen-year-old Noorbano from Khuzdar, Balochistan, is one such woman. She walks slowly towards the dining area from her bed in the recovery ward of the Koohi Goth Hospital. Her wounds are still raw. She has had three surgeries and has three more to go. “I developed the fistula during the birth of my second baby who did not survive. I would keep leaking all the time. Nobody even wanted to sit next to me,” she explains with the help of a translator. “It’s my husband who supported me. He had a few goats which he sold for my treatment. We travelled from Khuzdar to Hub and from there to Karachi. It was worth it,” she says with a smile.

As fistula is directly related to poverty and lack of resources, Balochistan has the most patients, followed by rural areas of Khyber-Pakhtunkhwa and Sindh.

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Pakistan’s understated scandal

“Is it not the biggest scandal that 30,000 young women are dying every year due to pregnancy-related causes and no one cares?” says Dr Shershah.

The women suffering from obstetric fistula develop the condition when child birth is not done by trained medical persons and the nearest hospital is at times hours away in rural Pakistan with no infrastructure or money to travel. “If the labour is prolonged, which is mostly when the woman is having her first baby, the baby’s head may get stuck in the birth canal in a way that it keeps pushing against the thin wall between the bladder or rectum and the wall of the birth canal, thereby causing and tear,” says Dr Suboohi Mehdi, one of the surgeons at Koohi Goth Hospital.

Another way a fistula may be formed is when an unskilled surgeon performs a surgery and by mistake causes a cut in the bladder or rectum.

Apart from treating women at the Koohi Goth facility, completely free of cost, a midwifery school is training midwives to help women deliver safely. Surgeons are trained to perform the surgeries, and teams then setup small units all over Pakistan. The patients are taught life skills and vocations during the long rehabilitation process. The hospital relies on donations for its running.

The answer lies in efforts for better maternal health for the women of Pakistan.

“The dream is very simple – that every woman has a right to basic obstetric care, in case of an emergency, at her doorstep, free of charge. And it can be done,” says a hopeful Dr Shershah.